MSE 6301 Unit II Article Critique For this assignment, you will locate and then critique an article from the CSU Online Library. Begin by selecting a contemporary safety issue for today’s first respo

Miller School of Medicine, University of Miami, Miami, FL, USA Correspondence Tyler Harrison, Department of Communication, School of Communication, University of Miami, Coral Gables, FL, USA Email: [email protected] Fire rescue organizations are central to community models of resilience, especially in the context of crisis. The ability of fire rescue organizations to fulfill their role relies on their ability to operate at full capacity; however, fire rescue services may face internal crises that require these organizations to be resilient in their own right.

This study uses grounded theory drawing on concepts of organizational culture and resilience to show how one key partner in the community model of resilience (Palm Beach County Fire Rescue) is working to address their own crisis—an epidemic of cancer. Firefighters are engaging in behaviours to increase resilience by working towards cultural change to reduce cancer risk, using social capital to increase net- works and expertise, and utilizing internal assets to enact change. Barriers to change include cultural practices, perceived threats to occupational practice, and logistics and resources to enact desired change. A model of risk reduction and resilience is advanced that explores how organizational culture and practice both support and undermine individual resilience and organizational resilience. Implications for com- munication and change efforts are explored. 1 | INTRODUCTION Community models of resilience emphasize the intrinsic relationship between community resilience and the organizations that help con- stitute that community (e.g., Doerfel, 2016; McManus, Seville, Vargo, & Brunsdon, 2008). Fire and rescue organizations are first respon- ders during natural or man-made disasters. Their efforts to accom- plish their goals depend on their ability to operate at full capacity.

However, fire rescue organizations, and other first responders, may also face crises that require the organization and their members to be resilient in their own right. This study advances a grounded the- ory approach to culture change and resilience to show how one fire rescue organization is striving for organizational resilience in the face of their own internal crisis—in their words, an“epidemic”of cancer, where cancer has surpassed heart disease and injuries as the leading cause of firefighter deaths, accounting for an estimated 60% of line of duty deaths nationwide (Elliott, 2016). Historically, the culture of firefighters instills resilience in the face of danger, but theprofession’s traditional cultural symbols and practices might make individual firefighters less resilient to unexpected risks. Moreover, efforts to reduce risk are complicated by organizational culture and occupational practices that challenge proposed adaptive changes. A model of risk reduction and resilience is advanced, and implications for communication and change efforts explored. Ultimately, the abil- ity of fire rescue organizations to create internal resilience is critical to their ability to add resilience to the community. 2 | THE CONTEXT OF A FIRE AND RESCUE CRISIS: AN EPIDEMIC OF CANCER Historically, firefighting has been organized to prevent risk based on the dangers of fighting fires, and these organizing processes have been very successful at reducing line of duty deaths from injuries.

Data show that line of duty deaths has decreased significantly since the 1970s, with the exception of 9/11. In 2015, there were only 68 DOI: 10.1111/1468-5973.12182 J Contingencies and Crisis Management.2017;25:171–181. wileyonlinelibrary.com/journal/jccm©2017 John Wiley & Sons Ltd |171 line of duty deaths from trauma or cardiac arrest (National Fire Pro- tection Association, 2016). However, recent epidemiological data on cancer incidence suggest that firefighters’lives may be endangered by occupational risks besides the obvious risk of running into burn- ing buildings. Meta-analysis (LeMasters et al., 2006) reveals a 1.2– 2.0 increased risk for firefighters (compared to the general public) developing a variety of cancers, including multiple myeloma, non- Hodgkin lymphoma, testicular, and prostate cancer. Additionally, female firefighters have overall higher cancer risk than the general population, including over a fivefold increased risk for cervical cancer and Hodgkin’s disease (Fangchao, Fleming, Lee, Trapido, & Gerace, 2006). Some fire services are reporting even higher incidents of can- cer; Boston Fire Department reports 67% of line of duty deaths between 2002 and 2014 were cancer-related (Elliott, 2016). Addi- tionally, cancer has surpassed cardiac arrest as the leading cause of death (Tyson, 2016). While these figures are not linked directly to cancer registries for independent verification, they have created what many firefighters view as a crisis. To date, there has been no systematic study of how firefighters actually perceive their cancer risk, or how they view work as related to that risk.

Research on causes of firefighter cancer has started to focus on firefighters’occupational exposure to known carcinogens, which likely occurs in two ways: inhalation and absorption. Inhalation of toxins and carcinogens is likely to occur when firefighters are not using self-contained breathing apparatus (SCBA), or when they are exposed to off-gassing from dirty gear (e.g., Fent et al., 2015). Fent et al. (2014) found that even when wearing personal protection equipment (PPE)appropriately, firefighters still had increased biomarkers (urine, breath) of carcinogens in their bodies, indicating that absorption is likely occurring through the skin or through inhala- tion of off-gassing when doffing turnout gear. While many in fire rescue services are aware of these issues, the culture and practice of firefighting create barriers to risk reduction and change. Although dermal exposure represents a“significant route of firefighter expo- sure,”(Alexander & Baxter, 2014, p. 47) recent findings show that new firefighters often base decisions on use of PPE on peer pressure from more senior firefighters, further supporting claims of the impor- tance of culture in relation to safety (Maglio, Scott, Davis, Allen, & Taylor, 2016). This crisis provides opportunities to explore the unique intersections of resilience, organizational culture, and health assets in fire rescue organizations.

3 | FIRE RESCUE ORGANIZATIONS AND RESILIENCE Research on organizational resilience focuses on ways to improve resilience and often centers on predictors of resilience. McManus et al. (2008) stress the importance of situational awareness and man- agement of keystone vulnerabilities—something fire services do exceptionally well given their training specifically for situational awareness and vulnerability management that begins in their training academies. Many fire rescue organizations operate on levels of strictcentralization, hierarchy, and top-down chains of communication and command during routine operations, but they may also provide opportunity for innovation and localized decision-making during times of crises (Weick & Sutcliffe, 2001). Emergency situations are all unique, and the ability to both follow command and direction, as well as to adapt to a specific call is essential to the safety and effec- tiveness of fire rescue operations. Mallak (Coutu, 2002; Mallak, 1998) argues that localized innovation is essential to resilience as it helps create solutions out of whatever is available. This bricolage (Weick, 1993) is a central element of resilience (Mallak, 1998).

While fire rescue organizations demonstrate tremendous resili- ence in the face of expected dangers (i.e., natural disasters, fires), McManus et al. (2008) argue that situational awareness goes beyond the routine and includes connections with wider stakeholders and understanding of the hazards and consequences an organization faces. Additionally, they argue for the development of an organiza- tional culture that is flexible and adaptive, where both culture and leadership structures allow for effective decision-making in both day-to-day and crisis situations, a concept also known as adaptive capacity. Boin and McConnell (2007) identify further facilitators of resilience, including the presence of trusted community networks that provide expertise; However, where there is overreliance on top- down approaches, these facilitators are complicated by barriers such as individual psychological defense mechanisms, organizational beliefs and rationalizations, the cost of preparation or change, and issues related to governance. This tension between top-down and bottom-up influence holds the potential to impede creativity (Som- ers, 2009); therefore, finding the appropriate balance is key for resili- ence.

Fire rescue organizations are also unique in that they develop strong cultures that both positively and negatively influence these processes of adaptability and change that are so important to resili- ence. Historical cultural behaviours are designed to instill trust and reliability in the face of immediate danger, but changes to a culture that has been isomorphic with many firefighter values and work practices are difficult, even in the face of new dangers. Wenger’s (2016) keynote remarks to the National Hazards workshop critiqued communication research in health, risk, and resilience as guilty of using outdated theory,“Laswellian in scope,”and which ignores the importance of the broader role of context. He emphasized a need to focus on the central role of culture—an approach we take in this study. 4 | FIREFIGHTING CULTURE Studies of firefighters’organizational culture have typically focused on the ways that cultures relate to control (e.g., Bullis & Tomp- kins, 1989) or the ways that the management of culture can increase the safety of firefighting practice (e.g., Thackaberry, 2004). Organizational culture consists of symbols, artifacts, and values that directly impact organizational values and occupational practice; consequently informal communication between members 172 | HARRISON ET AL . is as central to the creation and maintenance of organizational culture as communication via formal channels.

Fire rescue organizations are replete with cultural artifacts, such as fire apparatus, rescue tools, and customized built environments that highlight firefighters as masculine, rugged, and reliable—values central to firefighter culture (Thurnell-Read & Parker, 2008). Few artifacts are as strongly symbolic as bunker gear. Cultural artifacts that are visible and tangible, like dirty gear, carry a sense of machismo and signify reliability, knowledge, expertise, and profes- sional competence. Gear is not seen as just a tool, but is some- thing that is imbued with symbolic importance. Ultimately, these symbols go beyond superficial appearance and serve an important role in establishing trust and reliability, values that are critical where members rely on their colleagues to be able to save their lives in dangerous situations (Colquitt, Lepine, Zapata, & Wild, 2011; Myers, 2005).

However, dirty bunker gear, once a widely accepted symbol of hard work and trust as a firefighter, is increasingly being seen as problematic in terms of health risks. Dirty gear can lead to ongoing exposure to carcinogens through direct contact with the skin, and indirect exposure through off-gassing when gear is stored or trans- ported (Fent et al., 2014; Firefighter Cancer Support Network, 2013). Increased knowledge of cancer risk caused by dirty gear has led South Florida firefighters to push for a culture shift focused on cancer prevention by promoting gear cleaning. This project investi- gates the process of culture change and resilience in a fire rescue organization during times of internal crisis.

5 | THE CASE STUDY: PALM BEACH COUNTY FIRE RESCUE Palm Beach County Fire Rescue (PBCFR) is working to change cul- ture and reduce cancer risk among their firefighters. They engage in many practices known to be effective in increasing resilience, includ- ing bricolage, (the ability to improvise and make do; Weick, 1993) as well as the utilization of health assets and social capital to engage external stakeholders—key elements in community models of resili- ence (e.g., Chewning, 2016; Doerfel, 2016). Rather than looking to cure disease, a health assets approach examines communities and organizations for existing assets that may be utilized to improve overall health (see Morgan, Davies, & Ziglio, 2010 for additional dis- cussion). This approach fits well with models of resilience that draw on adaptive capacity and interconnectedness between organizations (Doerfel, 2016). PBCFR has worked within these parameters by drawing on social capital to bring external collaborators to the table, working within the organization for solutions that can be easily enacted, and drawing on both leadership and rank-and-file members to organize for change to reduce risk, improve health, and increase resilience.

Palm Beach County Fire Rescue have demonstrated situational awareness by connecting withexternalstakeholders with relevant expertise to help address their vulnerabilities (e.g., McManus et al.,2008). Specifically, as a result of increased awareness of cancer- related deaths and high-profile cancer cases in the fire service, a vol- unteer firefighter cancer team (Firefighters Attacking the Cancer Epi- demic: FACE) formed to help address these issues, leading to collaboration with the nearby cancer center and university to study cancer risk and assist in finding solutions. This team also draws on internalhealth assets by selecting members who bring varied exper- tise (i.e., biochemistry, leadership). Additionally, the FACE team works on internal initiatives designed to reduce cancer risk, including implementing a hood swap program, piloting cleansing wipes and field decontamination procedures, and cancer awareness training for command officers. Finally, and key to network theories of resilience (Doerfel, 2016), members of FACE help create connections between their organization, other fire services, and community partners to help disseminate best practices to reduce risk and increase resili- ence.

This leads us to our research questions:

RQ1: How do firefighters perceive their risk as part of the“cancer crisis?”RQ2: What cultural meaning do fire- fighters associate with the cultural artifact of bunker gear?RQ3: How do fire rescue organizations address competing tensions of desire to change to reduce risk versus stability that comes from hierarchy and estab- lished practices?RQ4: How do occupational demands in the fire service facilitate or hinder attempts to reduce risky cultural practices? 6 | THE STUDY Palm Beach County Fire Rescue (PBCFR) is a large fire service in South Florida that has approximately 50 stations and 1500 employ- ees. The fire service covers most of one large county that encom- passes both urban and rural populations of approximately 1,000,000, functioning in ways typical of fire rescue services across the United States.

6.1 | Participants and procedures Our research (IRB approved) was conducted over the course of sev- eral months with over 150 hours of observation and ride-alongs with 18 shifts (representing 15 stations from three battalions). Ride-alongs and observations included a mix of urban and rural stations, as well as busy (averaging 30+calls a day) and quiet (averaging 1–2 calls a day) stations. For observations we showed up prior to shift change so we could observe morning rituals, shift handoff behaviours, and morning meetings. We typically observed for 10–12 hr at a time, and occasionally for the full 24-hour shift to make sure we observed all processes. We were frequently invited to join firefighters for communal meals, a time when socializing and storytelling was highest. HARRISON ET AL . |173 Ride-alongs and observations informed four focus groups, broken into specific firefighter positions: firefighters with 3+years of experi- ence; drivers; captains and lieutenants; and specialty captains.

Because of the hierarchical nature of fire rescue organizations, sepa- rating by rank ensured the greatest likelihood of full participation by each member. This is important as different ranks have different occupational responsibilities during routine activities and critical inci- dents. Focus groups lasted for 90 minutes. Focus group participant age ranged from 29 to 58, with a median age of 51. Participants were recruited through distribution of flyers to the fire stations.

Additionally, no station had more than one participant in each focus group. Overall, approximately 110 firefighters were observed during ride-alongs, and 17 participated in focus groups. 6.2 | Data and analysis Field notes and focus groups recordings were transcribed intoNVivo for coding and analysis. Data were coded based on content (i.e., can- cer, gear) and theoretical constructs (i.e., culture, practice) and modi- fied and adjusted as natural categories arose from the data.

Utterances and observations could be coded into multiple categories (i.e., cancer, uncertainty). Coding was conducted by three trained team members. An initial segment of field notes was coded by three team members, and areas of disagreement were discussed and resolved. We followed Strauss and Corbin’s (1990) constant compar- ative method and codes were analysed for recurring themes, starting with parent codes, such as“bunker gear.”As general themes emerged, we moved deeper to subcodes to explore how a concept like bunker gear is relevant to culture, cancer, and work practices.

Additionally, the codes served as a foundation for deeper analysis, following Snow, Morrill, and Anderson’s (2003) approach of linking ethnographic data to larger theoretical and contextual structures. For example, when exploring attitudes towards gear cleaning, relation- ships between gear and occupational practice were explored—such that someone could have positive attitudes towards gear cleaning, but might not clean their gear because of specific demands of the job (i.e., busy stations have less downtime, slower stations have fewer fires and less frequent need to clean gear). As such, our analy- sis moves from initial thematic analysis about cancer and culture to explore deeper relationships between meaning and practice and the tensions that arise from competing cultural and occupational prac- tices. We further sought out areas of triangulation between field notes and focus group transcripts, as well as areas where meaning was contested. Finally, we engaged in member checks with key informants and presented our results to multiple groups of firefight- ers for feedback.

Categories for reporting are based on prevalent themes, and quotes are illustrative of the predominant pattern of findings. As the data come from both field notes and transcribed focus groups, it is impossible to give an accurate numerical count of instances, as field notes are not able to capture all relevant specific quotes and instead focus on key highlights and summaries of conversations throughout the day. Quotes were chosen for their ability to summarize keypatterns that are prevalent across the data for a given concept, but also for ability to highlight how firefighters think and talk about key issues. When challenges to dominant positions in the data are pre- sent, we also highlight these. 7 | RESULTS Our research questions focused on perceptions of cancer risk, cul- tural meaning, cultural change and the tensions that exist between culture and hierarchy in fire rescue organizations. Ultimately, the findings of these research questions have important implications for resilience in the face of crisis. Our results show that attempts to address the cancer crisis are driven by knowledge and beliefs about cancer. Firefighters are (overly) aware of and concerned with cancer risk and believe that organizational culture change can reduce some risks. Culture change is driven by both top-down (hierarchy) and bot- tom-up (culture) processes, with a goal of“meeting in the middle”to create routine practices (resilience). However, culture change is fraught with tensions between the need for short-term efficacy of the organizational mission (service, efficiency, safety; e.g., Boin & McConnell, 2007) versus long-term risk reduction (cancer). Ulti- mately, the elements of culture and hierarchy that instil resilience in the face of everyday risks may make it more difficult for individual resilience in the face of uncertain risk.

7.1 | Knowledge and beliefs about cancer RQ1 asked how firefighters perceive their risk as part of the“can- cer crisis.”The success of culture change, related to cancer risk is likely to be dependent on perceptions of cancer susceptibility.

Overall, our findings suggest that work done by the Firefighters Attacking the Cancer Epidemic (FACE) team has resulted in a high level of perceived cancer risk, but firefighters may actually overes- timate the risk. During our ride-alongs, every firefighter was aware of and concerned about increased cancer risk, providing us a range of estimates of the number of firefighters that would get cancer, with the most common responses falling into three roughly equal categories:“1in3;”“52%;”or“everyone will get cancer.”The 1 in 3 estimate and the 52% estimate came from internal unofficial reports of cancer rates that were shared among a few firefighters and then spread across the ranks. Tony’s statement during a focus groups sums up what many of the more fatalistic firefighters told us during our observations:“We’re not gonna be able to prevent it. It’s not a matter ofif,it’s a matter ofwhen. Because I think anyone sitting here [is gonna get] some type of cancer, I have no doubt in my mind.”Even in the face of this risk, all firefighters in our study (including those diagnosed with cancer) said there is nothing they would rather do than be a firefighter. This desire to be a firefighter in the face of long-term uncertainty and cancer risk suggests that resilience is not strictly in the face of overcom- ing or responding to immediate danger, but rather“builds on the foundation of the resilience of members of that organization (Riolli 174 | HARRISON ET AL . & Savicki, 2003, p. 28)”that is culturally instilled. There is a belief in the importance of the work that pushes them to carry on regardless of the risk.

Firefighters attributed causes of cancer to a variety of sources, including structural/occupational issues that lead to diesel exhaust exposure and other work-related factors such as exposures at fires and from dirty gear. While individual firefighters may not be able to make structural changes to the work environment, individual beha- vior change in gear cleaning may help reduce cancer risks. Recent research has shown that overestimation of risk to the point of fatal- ism can actually prevent behavior to reduce those risks, while accu- rate perceptions of risk combined with steps to reduce risk lead positive behavior change (Kerwin, 2016). Thus, while the goal of the FACE team is to create cultural change, change often entails action beyond collective behavior; addressing structural and financial, as well as other unintended or unanticipated, barriers is essential as they may be inadvertently decreasing resilience in some members of the organization.

7.2 | The symbolic meaning of gear: A badge of honor RQ2 asked what cultural meaning firefighters associate with bun- ker gear. When asked to give an estimate, firefighters in our study converged on an estimate of 80% of firefightershistorically valued dirty gear as a badge of honor. Dirty gear signified experi- ence and symbolized firefighters who were reliable and could be trusted with the lives of fellow firefighters. While new recruits and those only on the job for a couple of years had fewer stories about dirty gear, the majority of the more senior firefighters (typi- cally those who had 5 or more years of service) had stories about dirty gear and how dirty gear signified expertise and identification with being a firefighter. As one firefighter told us:“Younger days..., it was a badge of honor to have dirty gear. The dirtier, the better. [It] meant you worked harder than everybody else. We never cleaned it.”In fact, many of the more seasoned firefighters told us that before mandatory annual cleaning was implemented the previous year, they had never cleaned their gear. Firefighter Juan told us that even when they got new gear they intentionally burned it to help project the right image.

“...we got new gear, purposely exposed it to the high heat to melt everything. [...] to give you that culture of, you know, badass firefighter or whatever and we’re not finding that (any more).” While a small portion of the older firefighters appears to still value dirty gear and it still holds symbolic importance as a sign of reliability and expertise, there is acknowledgement that dirty gear is problematic, and the vast majority of the new generation of firefight- ers recognize that dirty gear can be associated with cancer risk.

Unfortunately, this does not necessarily translate into regular clean- ing of gear, for a variety of reasons. 7.3 | Cultural change and turnout gear RQ3 asked how fire rescue organizations address competing ten- sions of desire to reduce risky cultural practices versus inertia and stability that come from hierarchy and established practices. Our results show the work of the FACE team and increased concerns about cancer are driving change in the culture of the fire depart- ment. Firefighters recognize that this change is occurring, but see it as an ongoing process that must be driven from both the top and the bottom of the organization, with the goal of meeting in the mid- dle. Finding this balance between top-down influence and bottom- up influence is crucial to resilience (e.g., Dalziell & McManus, 2004; McManus et al., 2008). Below we explore the ongoing process of change occurring in PBCFR and reasons why others may still value dirty gear, acknowledging the historical importance of the meaning behind dirty gear.

Firefighters in our study estimated that only about 20% of fire- fighterscurrentlysee dirty gear as a badge of honor (inverse from the historical 80%). We were able to triangulate this figure with our ride-alongs and observations, including one station that had a sepa- rate gear room where 15 of 18 (83%) sets of gear were relatively clean. As firefighter Ellis summed up,“it’s not this badge of honor anymore to have the melted shield or anything like that.” While many firefighters who still wear dirty gear are still respected, they are starting to be seen as“dinosaurs”that embody old school values and“macho”actions that disregard dangers that are now being framed as the potential causes of cancer.

Tony: Times have changed. My first shift, first day, first call, [we were] rookies [going on a] structural fire. [There was] smoke pouring, black smoke, the LT [lieutenant] at the time, he looked at me, and I’ll never forget that, he looked at me and goes“Son, don’tdoasIdo”and he went inside that apartment, pouring black smoke, no SCBA, no mask, nothing...You don’t see that anymore.

[The LT] has got stage 4 prostate cancer. I don’t know whether it’s because of the fire service, or whatever, but he’s one of the older dinosaurs.

These quotes illustrate that firefighters in PBCFR are witnessing a culture shift where new meanings are being associated with dirty gear and exposures to potential carcinogens, and that occupational practices are changing to reduce risk. Below we explore how fire- fighters view and experience this process of transformation, includ- ing the tensions that occur as part of organizational change.

7.3.1 | Change from below (firefighters, new recruits, and the academy) While attitudes towards dirty gear are changing, firefighters identify change from below as one mechanism for long-term sustainable change and resilience. One area where change at the lower levels is occurring is the training academy. HARRISON ET AL . |175 Demetrius: We’ve changed the ways we do our training burns. We’re not burning tires, we’re not burning couches anymore, we’re not burning used oil...We used to put 55-gallon drums worth of used oil, just to get some nice black smoke and some nice orange fire...now it’s pallets and hay, clean burn, kind of thing.

While changes in practice are important, there is a belief that more can be done. The exchange below identifies the importance of social norms and modeling appropriate behaviours for the next generation.

Ellis: Are we doing a better job? Some of [the training instructors’gear] looks pretty burnt to me...Do they wash their gear? What does that now teach the new guy? The brand new guy, he’s 18-21 years old, he’s never been in the fire service, and he’s had no exposure to the fire service, he’s coming in and now he’s learning from these training guys,“Man, look how dirty that gear is.” While some change is occurring, different perspectives between the new and older generations of firefighters can be difficult to bridge. New firefighters learn new skills and techniques that often come into direct conflict with existing occupational and cultural prac- tices (e.g., Minei & Bisel, 2012). However, there appears to be a desire for change among many of the older generation of firefight- ers. We explore this in more detail below. 7.3.2 | Change from the top (formal PBCFR leadership and individual leadership) While firefighters see the new generation bringing change from below, they also see the importance of change being led from the top, both in terms of formal leadership and individual leadership from senior and respected firefighters.

Harry:Tome,yougottostartatthetopinanorganiza- tion. If you want to make meaning change, it’s gonna come from [the top]...Idon’t want to say we are followers, because then we are like zombies, but we are worker bees.

The boss bees are the ones that have to grasp this stuff if they want everybody below them to take it.

This distinction between leaders and followers makes sense in the context of hierarchical organizations. But fire services are also very localized with many on-the-ground daily processes implemented and led at the station level. The quote below shows the importance of individual leadership at the station level as a way to enact change.

Roberto: But I think us as guys that are respected at our stations, and you’re not, pardon my French, adouchebag, you know. When I tell this person that’s been on the job for a year and a half, I’m like,“Look, don’t put your gear in the cab. You put it in the side compartment.”When they respect you and they know that you are trying to do something to benefit them, you are gonna get more out of that. But it has to be us, as leaders to tell these people this is what needs to be done to protect yourself. [...] I don’t want to see these kids get pancreatic cancer.

While most participants in leadership positions agreed with the sentiments above, they were not always consistent in practice. The example below illustrates a rare exception by a captain who made decisions that went beyond standard policy about gear cleaning in an effort to protect his crew.

Ben: I would say 100% [of the time after a fire we clean our gear]. You know why? Because I don’t really give (pauses)...I’m going to answer you; this is what I do at my house. 100% of the time when we go to, whether it is a car fire or not, I make them change their hoods, we scrub our air packs, and we scrub our gear.

While this was an exception in terms of consistency in a leader’s approach, it sets a precedent in the focus group, with other captains and lieutenants saying they were going to try to do the same thing at their station. This process of listening to and learning from other respected firefighters demonstrates the importance of social capital and networks in change attempts (e.g., Chewning, 2016; Doerfel, 2016). This informal process mirrors the health asset approach for- malized by the FACE team. 7.3.3 | Meeting in the middle While top-down and bottom-up efforts are ongoing, most firefight- ers see cultural change as a gradual process where the“Senior Jakes”(the older generation of firefighters set in their ways) will eventually change their attitudes and behaviors or retire. As new recruits with new attitudes and training come up through the ranks, they will eventually meet in the middle and change will become rou- tine and stable. While there is optimism expressed about change, we did observe some teasing of the some of the newer generation of leaders in the fire service who were the most rigid about gear clean- ing. Nonetheless, they were still influential in changing practice in their station, often as a result of being in formal leadership positions and adherence to hierarchical leadership from lower ranking mem- bers. Making change routine, however, takes time, and as one cap- tain expressed,“Although there is still a lot of room to go, they [will] eventually kind of meet in the middle, and then change will become automatic and routine.” Overall, these findings indicate that firefighters believe that an extensive culture shift is taking place, but that it will take time and 176 | HARRISON ET AL . conflict for it to become routine. These changes are difficult in part because of the symbolic meaning attached to cultural artefacts like gear, but there are also occupational practices that create tensions for some of the changes being advocated. The section below illus- trates how culture and practice can actually impede progress towards better safety procedures.

7.4 | Tensions between desired cultural practices and existing occupational demands RQ4 linked issues of gear to the context of occupational practice and focused on how occupational demands facilitate or hinder attempts to reduce risky cultural practices. Our results show changes in the interpretation of the meaning of dirty gear—the cultural and symbolic value of demonstrating reliability and expertise is no longer as strong. However, new meanings have not taken hold—clean gear is seen as more normative, but lacks the cultural and symbolic impor- tance of dirty gear. This may be because clean gear does not have the same functional isomorphism with occupational practice as dirty gear. In many ways, dirty gear served not only as a symbol of relia- bility and expertise, but also fit well with nature of firefighting prac- tice—dirty gear requires no extra time or maintenance, which means firefighters can focus on short-term risk reduction of being fresh for new fires. Clean gear complicates work processes and may hinder what some firefighters see as essential to their work. For example, occupational and structural barriers may make the desired practices of field decontamination, showering, and routine or advanced clean- ing of the gear difficult.

Specifically, firefighters expressed concerns with field decontami- nation practices, time and competing work demands, efficacy of cleaning practices, inconsistent knowledge of which fires are“dirty” fires, structural barriers to advanced cleaning, and barriers to using extractors to clean their gear. Some of these issues point to prag- matic benefits of dirty gear that further link culture and practice.

Below we briefly explore three of these tensions: issues of field decontamination, time/competing work demands, and concerns over efficacy.

7.4.1 | Gross field decontamination In demonstrating their adaptive capacity, the FACE team was working on innovative procedures designed to reduce risk. Gross field decontamination was one new protocol to reduce exposure risk that was being trialled at the time of the study. At a basic level, this process entails firefighters being sprayed down with low pressure, low-volume water to wash the worst of the contami- nants off the gear, cool the gear to help reduce off-gassing, and to“make it sticky”so that contaminants do not aerosolize. All of these should impact both inhalation and absorption exposure in the immediate aftermath of a structural fire. While the overall goal of this process is to reduce cancer risk, firefighters expressed many concerns related to how the process would affect their immediate safety and their ability to perform their jobs. Theseconcerns typically fell into three major categories: (1) concerns with getting steamed burns, (2) concerns with discomfort and lack of mobility, and (3) concerns about efficacy and unintended conse- quences. While these concerns were not universal, few firefighters aside from members of the FACE team initially spoke up in favor of the process.

Firefighters consistently talked about the frustration of having to put on contaminated and wet gear after coming back from a major fire. They expressed concern that if they wash their gear, the gear will be wet if they are called out for a second fire and they might end up being“steamed”in the next fire (water on the inside of the gear heating up to steam temperatures and burning the firefighters).

A second concern focused on impacts to mobility and overall dis- comfort when wearing wet gear.

Luke: You know, you’re soaked and then you gotta go out and work it again. They might be going on a motor vehicle accident, structural fire...[T]hey are nice and clean, they are showered up, now it’s an hour later they get a car, okay, it needs to be extracted, they put that stuff on, they are soaking wet and nasty again. [N]obody wants to do that.

Firefighters further elaborated that being wet impedes mobility, which is important to work and safety, thus making cultural accep- tance of field decontamination more difficult. Finally, firefighters raised concerns about efficacy and unintended consequences of field decontamination processes. From our field observation, we noted that they are not necessarily convinced that the field wash down is going to actually get the soot off and make any differ- ence, or get the chemicals off and make any difference. In fact, they think it might make gear more absorbent. Ultimately the con- cerns that firefighters have about the process of field decontami- nation largely focus on impacts on occupational practice and the ability to do their jobs, as well as the safety and the efficacy of the process. 7.4.2 | Time and competing demands for cleaning One of the realities of the fire service is that stations have very dif- ferent levels of activity, with busy stations running as many as one or two calls an hour, while slow stations may run one or two calls a day. Ironically, those most in need of cleaning often have the least time to clean their gear.

Harold: We come back from fires, the guys on the res- cue, they are tired because they run 15, 20 calls in a day. And now we just get a [fire call about a] pot on the stove, not a major fire, but the half of the kitchen burned away. What are they [appliances, cabinets, cleaning supplies] made of? What are we covered with?

All that shit is releasing chemicals. [Firefighters] come back, they want to lay in bed because they are tired. HARRISON ET AL . |177 There is a competing tension between the short-term desire to rest and be sharp for the next call and the long-term need for gear cleaning to reduce potential cancer risk. For many, the immediate occupational risk takes priority, a finding consistent with previous research in resiliency and fire rescue organizations (Boin & McCon- nell, 2007). Decisions about“down time”at busy stations are made locally by the captain, and the captain may also decide on immediate rest rather than long-term health and safety concerns, as demon- strated by this quote from a captain during one of our focus groups.

Tony: [T]he other day we ran 42 calls. [...] But as busy are you are, like that, I don’t apply the same rules that Roberto applies at his station because obviously my guys need some down time. [...] So every station, everybody, depending on how your day goes, you take it differently, you know?

The demanding nature of fire and rescue work means that stations operate differently on the ground, and this is one case where a top- down, command and control approach might be more effective, but only if balanced with additional policies to address concerns, such as changing policy to allow the procedure of“moving up”another station to cover calls while those who just returned from a call clean them- selves and their gear. While some districts are working on this approach, as the quote below illustrates, implementation can be difficult.

Terrence: [...] There is a new suggestion that after a fire...

you are supposed to come back, take off your gear, wash your face and stuff before you go back to service. But they were on a big fire, and I’m moved up to their zone because they were on this fire. As soon as they are back, they send me back. I’mlike“wait, they’re supposed to come up and cleaneverything.Andit’s really not initiated yet. 7.4.3 | Concerns with efficacy Firefighters also have concerns that the self-help steps they can take may not be sufficient to protect them. For example, routine cleaning involves scrubbing gear with laundry detergent and a scrub brush, and then hanging it up to dry. It is considered an intermediary level of cleaning—more in depth than field decontamination but less thor- ough than advanced (professional) cleaning.

Ben: Using a scrub brush or Tide is better than not doing anything at all, but that shit is always off gassing even if after the Tide. [...]I’mjustsayingwhat’savailableto51 stations right now, Tide and a brush is better than nothing.

Again, firefighters are engaging in bricolage and making do with limited resources. They are taking steps to reduce risk and increase resilience, even in the face of organizational inertia and personal uncertainty. 8 | DISCUSSION The findings of this study point to the importance of understanding how the unique culture of fire rescue and other first responder orga- nizations impacts resilience and attempts to manage risk during times of crisis. Firefighter culture has successfully instilled resilience in the face of immediate danger, but the profession’s traditional cul- tural symbols and practices place both the organization and individ- ual firefighters at danger from unexpected risks. Cultural change is difficult under the best of circumstances. When that change involves key cultural artifacts that have served important functions in judge- ments about trust and reliability in life threatening situations, and is inextricably bound to the nature of work that draws workers to such occupations, it can prove even more challenging. But, when those same existing cultural practices further endanger lives and health, deep understanding of the meanings, challenges, and barriers associ- ated with desired cultural change can help us craft ways to reduce risk and improve resilience at both the organizational and individual levels.

The Model of Change Processes for Risk Reduction and Resili- ence is presented in Figure 1. The context of fire rescue organiza- tions and the results of this study suggest that need forcultural changeis driven byperceived crises. Fire and rescue organizations may exhibit both dual manifestations of resilience: resistance to change and adaptive capacity (Limnios, Mazzarol, Ghadouani, & Schi- lizzi, 2014). Change occurs through bothtop-downandbottom-up processesthat influence bothmeaningandpractice. By using ahealth assetsapproach, internal and external resources can be harnessed, innovationscreated toaddress barriersbetweenshort- and long-term concerns, andmessages are designedto help shift meaning in line with new practices. When organizations are effective in realizing androu- tinizing changeto cultural meaning to reduce risk, bothindividual resi- lience and organizational resilience are improved.

This model highlights the many complexities inherent in change attempts and demonstrates that merely disseminating a written or spoken message, no matter how persuasive, is not sufficient. Culture is communicated through actions that are nonverbal, behavioral, and normative, and cultural meaning may be directly linked to organiza- tional behavior that supports (or hinders) resilience. It also demon- strates the importance of a health assets approach for resilience and suggests approaches such as asset mapping (McKnight, 2010) to help identify key organizational and community assets to support change.

When creating messages and interventions to change culture, reduce risk, and improve resilience, health interventions need to account for the specifics of organizational culture and socialization processes while recognizing the particular challenges associated with technical aspects of work and the built environment of firefighters (e.g., Barbour, Gill, & Dean, 2016; Harrison, 2016). Additionally, many occupational practices take on cultural meanings, and firefight- ers have many rituals associated with their work routines. Any approach to cultural change needs to take into account these unique attributes of meaning and practice. Communication design (e.g., Har- rison, 2014) should utilize traditional theoretical models of behavior 178 | HARRISON ET AL . change, but go beyond a single one-size-fits-all message to work cre- atively and systematically to situate intervention efforts to specific sites of implementation (Aakhus & Harrison, 2016; Harrison, 2014).

For example, communication design should account for the different work practices between busy and not busy fire stations, and the dif- ferent types of firefighters who choose to work in those environ- ments. Additionally, communication design should interrogate existing and new practices for unintended consequences, such as the fatalistic sense of risk for developing cancer that many firefight- ers have as a direct result of efforts to increase awareness of cancer risk—and which may act to prevent positive behaviour change and decrease resilience (e.g., Kerwin, 2016).

Palm Beach County Fire Rescue (PBCFR) seeks cultural change to decrease risk and increase both individual resilience and organiza- tional resilience. The process of change PBCFR is undergoing high- lights current risks associated with dirty gear, but for cultural and occupational change to occur, new meanings that support critical functions have to be created and organizing processes have to address barriers to change. Barriers to change demonstrate that changing cultural meanings that have unintended negative conse- quences is not enough (i.e.,“dirty gear isnota badge of honor”).

New positive associations need to be made that can acquire enough strength to encourage new action and the new meanings must fill the same functions of demonstrating trust and reliability, as that trust and reliance on others are essential to both individual resilience and organizational resilience. If clean gear can start to symbolize expertise and reliability, then the meanings of clean vs. dirty gear will begin to change. We anticipate that this will occur through a process of reframing, where clean gear symbolizes taking care of oneself so firefighters can keep doing the job of protecting others, protecting and caring for their families, and helping create a culture of safety and health for future generations of firefighters.

Additionally, while firefighters desire change, the organization itself must support resiliency by providing appropriate solutions (in terms of policies and resources) to help firefighters overcome prob- lems they encounter with change to reduce risk. Long-term risk reduction cannot come at the cost of short-term safety. This requires adaptability and rapid change in a variety of areas, includingplanning and preparation. For example, a consistent theme across focus groups and observations focused oncreating timefor recom- mended actions to be taken. Presently, the culture and hierarchy of firefighting organizations hinder this type effort, but small changes such as scheduling to keep firefighters out of service to provide time to shower, change, and do routine cleaning would show commitment to change. In line with observations about change coming from the top, these changes in policy and practice must originate with leader- ship—hierarchical implementation must occur until it becomes the cultural norm for rank-and-file firefighters.

In the absence of immediate large-scale funding to implement structural or policy changes that require additional resources, fire- fighters are demonstrating resilience by making do (Coutu, 2002) and developing temporary, low-cost solutions. By utilizing internal and external health assets, the FACE team is also directly increasing both organizational resilience and community resilience by develop- ing ties, increasing networks, and building social capital (e.g., Chewn- ing, 2016; Doerfel, 2016) that will help them in times of crisis.

Additionally, they are developing solutions designed to help over- come barriers to the adoption of better risk reduction processes dis- cussed in our findings. External health assets are providing expertise to validate the efficacy of certain approaches and to provide guid- ance on other issues. Well-designed messages drawing from existing theories of health communication and behavior change, tailored to the specifics of context, should help address ongoing concerns and facilitate both culture change and risk reduction behavior. Effective messages used in conjunction with demonstrations of the efficacy of new procedures are key to successfully implementing change, which ultimately will increase both individual resilience and organizational resilience. 9 | CONCLUSION Firefighter culture is excellent at instilling resilience in the face of immediate danger. However, historical culture and hierarchy may also make change difficult and put firefighters at risk from unex- pected dangers such as cancer, thereby putting both individual FIGURE 1Model of change processes for risk reduction and resilience HARRISON ET AL . |179 resilience and organizational resilience at risk. The findings from this study show firefighters have high levels of concern with cancer risk.

They recognize the importance of a cultural shift where dirty gear is no longer seen as a badge of honor, but also recognize that there are occupational challenges to enacting changes that will decrease the risks created by dirty gear. Tensions between occupational requirements and processes designed to reduce risk require not only changes in the organizational culture of firefighters, but also changes in organizational policy and work practices to support change. Exist- ing organizational culture of firefighters has developed to serve specific needs related to the demands of high-risk occupations.

Attempts at changing that culture must take into account these demands and be responsive to the needs of firefighters to work in an occupation where lives are constantly at risk. The Model of Change Processes for Risk Reduction and Resilience is presented as a framework for cultural change to reduce risk and increase resili- ence. Ultimately, both individual resilience and organizational resili- ence are essential for fire and rescue organizations to be fully functional and contribute to community resilience in times of crisis.

ACKNOWLEDGEMENTS This work was supported by State of Florida appropriation #2382A (PI Kobetz) to Sylvester Comprehensive Cancer Center, subaward (PI Harrison) to the Center for Communication, Culture, and Change in the School of Communication at the University of Miami. The authors would like to thank the firefighters, unions, and support groups of South Florida.

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Held in Broomfield, CO. How to cite this article:Harrison TR, Yang F, Anderson D, et al. Resilience, culture change, and cancer risk reduction in a fire rescue organization: Clean gear as the new badge of honor.J Contingencies and Crisis Management. 2017;25:171– 181. https://doi.org/10.1111/1468-5973.12182 HARRISON ET AL . |181 Copyright ofJournal ofContingencies &Crisis Management isthe property ofWiley- Blackwell anditscontent maynotbecopied oremailed tomultiple sitesorposted toalistserv without thecopyright holder'sexpresswrittenpermission. However,usersmayprint, download, oremail articles forindividual use.